| East Texas Out-patient Pllc | |
|
116 N Houston St Edgewood TX 75117-1555 | |
| (903) 962-3419 | |
| (903) 385-3340 |
| Full Name | East Texas Out-patient Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 116 N Houston St, Edgewood, Texas |
| Authorized Official Name and Position | Jimmy W Dailey (OWNER) |
| Authorized Official Contact | 9035671910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Out-patient Pllc Po Box 76 Canton TX 75103-0076 Ph: (903) 962-3419 | East Texas Out-patient Pllc 116 N Houston St Edgewood TX 75117-1555 Ph: (903) 962-3419 |
| NPI Number | 1417511593 |
|---|---|
| Provider Enumeration Date | 04/24/2019 |
| Last Update Date | 07/01/2025 |
| Medicare PECOS PAC ID | 8820326275 |
|---|---|
| Medicare Enrollment ID | O20190822001823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417511593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jimmy W Dailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073598199 PECOS PAC ID: 3870508724 Enrollment ID: I20060214000089 |
Edgewood Rural Healthh Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 East Pine Street, Edgewood, TX 75117 Phone: 903-896-2222 |